As healthcare providers, we know there is pressure to decrease readmissions and length of stay -- but we don't always have insight into the mechanics of how and why. Our patients have even less grasp of why and how discharge decisions get made, a situation which can erode both trust and outcomes.
One thing is for sure: the average hospital stay is decreasing. As the New York Times reports, today's average stay is 4.5 days -- compared to 7.3 in 1980.
There are many potential reasons for these shifts, but data suggests that financial incentive is the main determinant. Recent changes affect who is admitted, how frequently, and how quickly they are discharged. For instance, Medicare's prospective payment system, which paid a predetermined rate and so shifted risk to the hospital is shown to have decreased length of stay.
Of course, slashing Length of Stay has consequences. In fact, many people point to the increase in readmissions that can accompany drops in length of stay. Or as Mr. Frakt shares, "A physician who practices at a Boston-area teaching hospital told me that hospital administrators exert social pressure on doctors by informing them that their patients’ stays are longer than that of their peers. "
This kind of social pressure or hard financial cutoffs to push numbers are like medical shortcuts. They seek to quickly drive "expensive" numbers down -- without significant investigation into the consequences. Of course, logic and experience tells us one simple truth: the only way to improve care, decrease readmissions, and decrease length of stay is through medical collaboration and coordination of care.
This isn't something tbat you can simply put in a memo. And there is no shortcut, but it is certainly possible. As we've shared before:
- Telemedicine supports overall health spending decreases without pushing other indicators out of alignment.
- Medical collaboration tends to decrease readmissions as well as decreasing length of stay -- by improving the care coordination that happens -- all without worsening overall outcomes.
It is hard enough to provide excellent medical care -- but short term fixes and social pressure definitely make it harder.